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PubMed2004

Treating functional impairment of autism with selective serotonin-reuptake inhibitors.

OBJECTIVE: To review literature describing use of selective serotonin-reuptake inhibitors (SSRIs) in the management of functional impairments associated with autistic disorder. DATA SOURCES: EMBASE (1980-3rd quarter of 2003), International Pharmaceutical Abstracts (1970-August 2003), and MEDLINE (1966-August 2003) were searched. Search terms included autism, autistic disorder, citalopram, fluoxetine, fluvoxamine, paroxetine, selective serotonin-reuptake inhibitors, and sertraline. DATA SYNTHESIS: Studies and case reports evaluating treatment outcomes associated with the use of SSRIs in managing impairments of autism were reviewed. Multiple SSRI dosing ranges were evaluated in autistic patients of different ages with various functional impairments. No specific SSRI or dose range has been shown to improve a specific autistic symptom although some patients have demonstrated improvements. CONCLUSIONS: Benefits with SSRIs in treating functional impairments in autism have been observed. Response to therapy and adverse effects are individualized. Current evidence does not support selection of one SSRI over another for any impairment associated with autism.

Autistic Disorder↗

PubMed1990

Developmental and family effects of autism.

Autistic disorder is a developmental disorder, the course of which grows out of the interaction of a chronic brain syndrome with the changes of maturation and development and a patchwork of habilitative programs. Definitive intervention awaits better definition through neuroanatomic and neurobehavioral studies. Investigation of known etiologies, referral for and coordination of habilitative services, and ongoing partnership with the family remain the mainstays of management of this challenging disorder.

Autistic Disorder↗

PubMed1996

Autism spectrum disorders in children with physical or mental disability or both. II: Screening aspects.

The Autism Behavior Checklist (ABC) was used as a screening instrument in a study of autism spectrum disorders in a population of children with mental retardation or physical disability or both. The ABC score clearly reflected behavioural problems found in children with mental retardation and not only behaviours typical of autism. If the cut-off score used was 45 (lower than recommended by the original investigators), children with autistic disorder without multiple other disabilities were reliably identified, with an acceptable rate of false positive cases. In order not to miss other autism spectrum disorders, all cases with several omitted items in their checklists were examined in more detail. The Childhood Autism Rating Scale (CARS) distinguished reasonably well between autistic disorder and other autism spectrum disorders.

Adolescent↗

PubMed2005

Pervasive developmental disorders rating scale: development and construct validity.

The Pervasive Developmental Disorders Rating Scale was designed for use in screening of pervasive developmental disorders. This paper describes the rationale and development of the scale and assesses its construct validity with ratings from a sample of 362 children ranging in age from 1 to 12 years and diagnosed with autistic disorder. The hypothesized heirarchical factor model and two competing models were examined through confirmatory factor analysis. The analysis supported the factor structure of the hypothesized model in this particular sample of children with autistic disorder. Limitations and areas for research are discussed.

Affect↗

PubMed2003

fMRI study of recognition of facial expressions in high-functioning autistic patients.

Autistic disorder is associated with deficits in social function. The disorder may be related to dysfunction in the brain regions that are involved in the process of recognising facial expressions of other persons. Using fMRI, we investigated whether autistic patients with relatively high IQ would have different brain activation on the tasks of recognition of facial expressions (i.e. faces expressing disgust, fear, and happiness) compared with normal control subjects. In disgust and fear recognition tasks, there were different patterns of brain activation in the cortico-limbic neural circuits qbetween autistic and normal groups. Patients with autistic disorder may have difficulty in grasping facially expressed qemotions in others, and thereby cannot manipulate the interpersonally derived information.

Adolescent↗

PubMed2005

Autism and mental retardation of young children in China.

OBJECTIVE: To understand the prevalence and rehabilitation status of autism and mental retardation in China. METHODS: Screening test and clinical assessment were conducted for the diagnosis of autism and mental retardation. The assessment included investigation of the histories of medical conditions and development of these two disorders, utilization and needs for the rehabilitation service, and related intellectual and behavioral appraisal. RESULTS: Among the 7345 children investigated, the prevalence of autism disorder was 1.10 cases per 1000 children aged 2-6 years (95% CI=0.34 to 2.54), and the prevalence of mental retardation was 10.76 cases per 1000 children (95% CI=8.40 to 13.12). All the children suffering from autistic disorder were intellectually disabled, whereas 31.0% of the non-autism mental retardates had other disabilities. The medical conditions prior to birth and perinatal period were important potential factors for autism. Half of the autistic children and 84% of the children with non-autism mental retardation had never received any rehabilitative service. CONCLUSIONS: The prevalence of autistic disorder in children aged 2-6 years in Tianjin is rather high. It is urgent to improve the status of the autistic and intelligently disabled young children in China. In order to upgrade the level of early diagnostic and improve the intervention to autism and mental retardation, public awareness and training courses should be heightened.

Autistic Disorder↗

PubMed2000

Repetitive thoughts and behavior in pervasive developmental disorders: treatment with serotonin reuptake inhibitors.

Repetitive thoughts and behavior are considered integral and core components of autistic disorder. Results from recent studies suggest that the types of repetitive thoughts and behavior of adults with autism and those with obsessive-compulsive disorder (OCD) may be different. Serotonin reuptake inhibitors (SRIs), the primary drug treatment for patients with OCD, may reduce the repetitive phenomena of some autistic patients. Two controlled studies of the nonselective SRI clomipramine have shown the drug to be more efficacious than the relatively selective norepinephrine reuptake inhibitor desipramine and placebo in children with autism. One controlled study of the selective SRI fluvoxamine found it to be significantly better than placebo for reducing repetitive phenomena and aggression in adults with autistic disorder. Additional research is needed.

Adolescent↗

PubMed2005

[Current approaches to understanding of autism in childhood].

The authors analyse the trends in the study of childhood autism in the XX century and state of the art in view of nosology, systematics, clinical phenomenology, etiology and pathogenesis of autistic disorders. Mental Health Research Center of Russian Academy of Medical Sciences proposes a new classification of autism in children basing on the study of 500 cases. Each form of autistic disorders is characterized in clinicopsychopathological and pathogenetic aspects. The phenomenon of autism in childhood psychopathology is universal, dependent on peculiarities of ontogenesis of the nervous system, individual development of a child, genetic and environmental factors.

Autistic Disorder↗

PubMed1998

Symptoms of pervasive developmental disorders as observed in prediagnostic home videos of infants and toddlers.

OBJECTIVES: The objectives of this study were (1) to show prediagnostic abnormalities in social and communicative behaviors on home videos of children who later received a diagnosis of one of the pervasive developmental disorders (PDD) and (2) to demonstrate that prediagnostic abnormalities in social and communicative behaviors for children with PDD not otherwise specified will be less prominent than those in children with autistic disorder but still distinguishable from those of typically developing peers. STUDY DESIGN: Parents of children with PDD each submitted home videos of social events that were made when their child was between the ages of 12 and 30 months, before diagnosis. Two independent observers, unaware of the subjects' diagnoses or purpose of the study, scored the rates of specific anomalies in social and communicative behavior. Two additional observers scored the percentage of time the children were engaged socially or with objects. Data from the experimental group were compared with those of 25 age-matched children with no developmental disabilities. RESULTS: Significant differences were found between the rates of social engagement and 8 of the 25 specific behaviors of the children in whom PDD was later diagnosed and those of the typical children. The children later given the diagnosis of PDD not otherwise specified had mean frequencies of some social interactions and communicative skills that fell between those of children later given the diagnosis of autistic disorder and those of children with typical development. CONCLUSION: In our sample children in whom PDD was later diagnosed could be differentiated from their typically developing peers on the basis of specific anomalies noted in their social and communicative behaviors, especially joint attention. In our sample children with PDD not otherwise specified could have been further differentiated on the basis of the rates of social interaction. Careful assessment of social interaction and communicative behaviors may help to identify children with PDD before the age of 30 months.

Autistic Disorder↗

PubMedDate not supplied

[Management of children with autism spectrum disorders].

INTRODUCTION: Autistic spectrum disorders (ASD) are characterized by qualitative deficits in communication, social skills and a restrictive repertoire of interests and behaviors. Recent studies suggest that they may represent one of the most prevalent neurodevelopmental disorders. METHOD: Treatment of core deficits of ASD are primarily speech and language, behavioral and educational interventions. Clinical management of ASD requires a multidisciplinary approach to identify behaviors that could interfere with the individual s ability to benefit from those interventions. Medications, such as neuroleptics, antiepileptic drugs, SSRI s, neurostimulants and others have been used to target specific behaviors. CONCLUSIONS: Further research is much needed if medications are eventually to have a greater role in the treatment of core ASD symptoms. Recent attempts at neurosurgical interventions cannot be justified by our present level of knowledge

Anticonvulsants↗

PubMedDate not supplied

[Pervasive developmental disorders: controversies concerning the classification of autism].

Autistic Disorder was described by Leo Kanner in 1943. Since that time not only the name of this disorder (initially early infantile autism) has changed but also it's relation to other disorders. DSM-IV includes autism together with Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder and Pervasive Developmental Disorder Not Otherwise Specified into one category: Pervasive Developmental Disorders. The definition and contents of Pervasive Developmental Disorders raise many controversies. Differentiation between particular disorders within this category is also difficult. This paper discusses some of these problems.

Autistic Disorder↗

PubMed2005

Comparison of childhood disintegrative disorder and disintegrative psychosis not diagnosed as childhood disintegrative disorder.

To clarify the difference of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) childhood disintegrative disorder (CDD) from International Classification of Diseases (9th revision; ICD-9) disintegrative psychosis (DP), 10 CDD children (mean age, 7.7 years) and 18 DP children (mean, 6.5 years) not diagnosed as CDD divided into DSM-IV autistic disorder (DP-AD; n = 11) and pervasive developmental disorders not otherwise specified (DP-PDDNOS; n = 7) were compared on 31 variables not directly related to the normalcy before regression. The CDD, DP-AD, and DP-PDDNOS groups did not differ significantly in 28 variables. The DP-PDDNOS group met significantly a smaller number of items in criterion A of DSM-IV autistic disorder criteria than the CDD and DP-AD groups, both of which did not differ significantly in this respect. The CDD group tended to be more abnormal in auditory responsiveness and verbal communication than the DP-PDDNOS group. While CDD is distinct from DP-PDDNOS, its validity apart from AD with regression remains to be studied.

Age of Onset↗

PubMed2005

A descriptive hospital based study of children with autism.

The clinical and neurodevelopmental profile of 51 children with Autistic disorder, from a referral population was studied. A detailed history and examination was undertaken. The development/intelligence quotient and social quotient were assessed. Standard diagnostic tests were applied in children above 2 years of age. Younger children were evaluated with a screening test and re-evaluated at 2 years. It was observed that a correct diagnosis had been made in only 5.8% of children prior to referral. The mean age of presentation was 3.28 years. Ninety-six percent of the autistic children had developmental delay. Qualitative impairment in social interaction and communication was more commonly observed than restricted interests and activities. Forty-seven (92.15%) children were severely autistic and 4 (7.84%) mildly to moderately autistic. All children less than 2 years were confirmed to have Autistic disorder later.

Autistic Disorder↗

PubMed2006

[Autism, neurodevelopment and early detection].

INTRODUCTION: Autistic disorder is briefly explained and defined in the light of recent research. DEVELOPMENT: From the perspective offered by ontogenesis and the acquisitions that take place during normal development, we present an updated vision of the genesis of autistic disorder and also review the most significant data provided by the different studies that have been conducted on the subject. Detection of the disorder is clearly a difficult task before the age of one year and, in any case, the earliest symptoms are clearly linked to the social and communicative interaction that characteristically takes place at the end of the infant's first year of life. CONCLUSION: Early detection of the disorder is made possible precisely because of alterations in social and communicative development and, in general, the appearance of psychological functions that play a significant role in the process of humanisation. The article concludes by pointing out the need for further studies that focus on the possible alteration of earlier socio-emotional and affective manifestations.

Autistic Disorder↗

PubMedDate not supplied

Psychopathology in children and adolescents with developmental disorders.

Children and adolescents with developmental disorders suffer from a wide range of psychopathology. However, there are no published studies examining this subject exclusively in this population using recent diagnostic criteria. The primary purpose of this paper is to report on the diagnosis encountered in a clinical setting using DSM-III-R. The medical records of all individuals assessed in a specialized program during a 1-year period were reviewed looking at their demographic features, diagnoses, and target behaviors. Our sample consisted of 233 subjects and contained significantly more boys than girls. The most common psychiatric diagnoses were oppositional defiant disorder and attention deficit hyperactivity disorder. Pica, organic mental disorder NOS, and Autistic Disorder were more often encountered in individuals with low intellectual functioning. Depressive disorders, posttraumatic stress disorder, and developmental speech/language disorders were diagnosed more in high functioning subjects. The most common symptom was impulsivity. This retrospective study highlights the need for more rigorous examination of current diagnostic concepts and criteria in children and adolescents with developmental disorders. Prospective studies should be conducted with standardized instruments in clinics and community samples to provide more information on psychiatric disorders in this population.

Child↗

PubMed1998

The use of psychotropic medication in preschoolers: indications, safety, and efficacy.

OBJECTIVE: To review the indications, safety and efficacy of psychotropic medications used in preschoolers. METHODS: Proprietary prescription-use databases indicate that practitioners are prescribing psychotropic medications for preschool patients at an increasing rate. A Medline search was conducted using drug exposure for children below the age of 6 years to identify efficacy and safety reports of these agents in the preschool age-group. RESULTS: The search yielded 22 reports that mention exposure to medications, including maternal exposure, accidental overdose, and adverse events in preschool children. Safety issues highlight the age-specific vulnerabilities of this age-group, including hepatotoxicity from valproic acid, among others. In addition, the prominence of adverse-event responses in this age group may be related to polypharmacy not seen in school-age children or adolescents. Less than a dozen controlled efficacy studies of psychotropic agents were identified for children in the preschool age-group. These are limited by the small numbers of subjects in the reports. Only 2 disorders described in the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV), attention-deficit hyperactivity disorder (ADHD) and autistic disorder, are mentioned. The Food and Drug Administration (FDA) approved psychotropic medications for preschoolers but limited their use to medical purposes, not psychiatric, with the exception of use for ADHD. CONCLUSION: Because data about psychotropic drug safety and efficacy in adults have not been extended to children, new psychopharmacological research is required before clinicians can use these agents to treat psychiatric disorders in the preschool age-group.

Age Factors↗

PubMed2007

Attachment in toddlers with autism and other developmental disorders.

Attachment was assessed in toddlers with Autistic Disorder (n=20), Pervasive Developmental Disorder (n=14), Mental Retardation (n=12), Language Development Disorder (n=16), and a non-clinical comparison group (n=18), using the Strange Situation Procedure (SSP). Children in the clinical groups were more often disorganized and less often securely attached. Severity of autism was associated with more attachment insecurity, and lower developmental level increased the chance for disorganized attachment. Attachment disorganization was related to increased heart rate during the SSP. Controlling for basal cortisol and developmental level, more autistic symptoms predicted lower cortisol responses to the SSP. The findings support the importance of disorganized attachment for children with autism.

Arousal↗

PubMed2006

Characteristics of the broader phenotype in autism: a study of siblings using the children's communication checklist-2.

Non-autistic relatives of people with autistic disorder have an increased risk of social and communicative difficulties: this is known as the "broad phenotype." Better methods for characterizing the broad phenotype are needed to facilitate identification of risk genes for autism. 29 siblings of 20 children with autistic disorder, 13 siblings of 9 children with PDDNOS, and 46 typically developing control children from 26 families were assessed by parental report using the Children's Communication Checklist-2 (CCC-2). Groups were matched on age and IQ and siblings with autism were excluded. Group mean scores on the CCC-2 differed on only one subscale, syntax. However, siblings of children with autism or PDDNOS were over-represented in the tails of the distributions of several scales, and 10 (24%) scored more than 2 SD below the control mean on a total score based on all 10 subscales. Only two of these 10 children scored above threshold on one or more scales of the Autism Diagnostic Interview-Revised (ADI-R). Children with abnormal scores on the CCC-2 total were characterized by low-verbal IQ and their fathers tended to score high on the social and communication scales of the Autism Quotient, a measure of the broad phenotype in adults. The CCC-2 shows promise as a quick screening device for the broad phenotype in non-autistic siblings of children with autism.

Adolescent↗